Atilla YİLMAZ, Murteza CAKİR

Is emergent cervical radiological evaluation mandatory in isolated cranial gunshot injury?

Aim: The aim of this study was to evaluate the accompanied cervical injuries of the patients presenting to the emergency department (ED) because of penetrating, perforating or tangential cranial gunshot injuries (CGI).Material and Methods: The retrospective study included 137 patients that presented to the EDs at Mustafa Kemal and Ataturk University due to penetrating, perforating or tangential CGI between 2014 and 2018. Patients younger than 12 years old and had insufficient radiological records were excluded from the study and thus 115 patients were included in the study.Results: 115 patients included 105 (91%) men and 10 (9%) women with a mean age of 27 (range, 12-65) years. Of the 115 injuries, 84 (73%) were high-velocity and 31 (27%) were low-velocity gunshot injuries. The injuries included 92 (80%) penetrating or perforating and 23 (20%) tangential injuries. No cervical dislocation injury was accompanied by CGI in any patient. Unilateral lamina fracture of the cervical vertebra was observed in one patient.Conclusion: Our results support the opinion that isolated penetrating, perforating or tangential CGI did not cause to cervical spinal injuries, the intubation or tracheostomy procedures should not be postponed after radiological evaluation of cervical spinal stability.

PDF

___

Deaths resulting from firearm- and motor-vehicle-related injuries--United States, 1968-1991. MMWR Morb Mortal Wkly Rep 1994;43:37-42.
Alvis-Miranda HR, M. Rubiano A, Agrawal A, et al. Craniocerebral gunshot ınjuries; A review of the current literature. Bull Emerg Trauma 2016;4:65-74.
Part 1: Guidelines for the management of penetrating brain injury. Introduction and methodology. J Trauma 2001;51:S3-6.
Aras M, Altas M, Yilmaz A, S et al. Being a neighbor to Syria: a retrospective analysis of patients brought to our clinic for cranial gunshot wounds in the Syrian civil war. Clin Neurol Neurosurg 2014;125:222-8.
Kadir Cınar, Mehmet Secer, Fatih Alagoz, et al. Outcomes and demostration of cranial firearm ınjuries: A multicenter retrospective study. (TJTES) 2015;21:291-96
Shaffrey ME, Polin RS, Phillips CD, et al. Classification of civilian craniocerebral gunshot wounds: a multivariate analysis predictive of mortality. J Neurotrauma 1992;S279-85.
Kumar A, Umamaheswara Reddy V, Pratyusha V, et al. Commonly available CT characteristics and prediction of outcome in traumatic brain injury patients. Romanian Neurosurgery 2017;31:101-10.
Kong V, Odendaal J, Sartorius B, et al. Civilian cerebral gunshot wounds: a South African experience. ANZ J 2017;87:186-9.
Barach E, Tomlanovich M, Nowak R. Ballistics: a pathophysiologic examination of the wounding mechanisms of firearms: Part I. J Trauma 1986:26:225-35.
Alvis-Miranda HR, Adie Villafane R, Rojas A, et al. Management of craniocerebral gunshot injuries: A review. Korean J Neurotrauma 2015;11:35-43.
Kanoff RB, Moncman MG, Henick W, et al. Cranial gunshot wounds. J Am Osteopath Assoc 1990;90:515-8.
Kennedy FR, Gonzalez P, Beitler A, et al. Incidence of cervical spine injury in patients with gunshot wounds to the head. South Med J 1994;87:621-3.
O’Malley KF, Ross SE. The incidence of injury to the cervical spine in patients with craniocerebral injury. J Trauma 1988;28:1476-8.
Neifeld GL, Keene JG, Hevesy G, et al. Cervical injury in head trauma. J Emerg Med 1988;6:203-7.
Bayless P, Ray VG. Incidence of cervical spine injuries in association with blunt head trauma. Am J Emerg Med 1989;7:139-142.
Potapov AA, Krylov VV, Gavrilov AG, et al. [Guidelines for the management of severe traumatic brain injury. Part 3. Surgical management of severe traumatic brain injury (Options)]. Zh Vopr Neirokhir Im N N Burdenko 2016;80:93-101.
Murphy JA, Lee MT, Liu X, et al. Factors affecting survival following self-inflicted head and neck gunshot wounds: a single-centre retrospective review. Int J Oral Maxillofac Surg 2016;45:513-6.
Potapov AA, Krylov VV, Gavrilov AG, et al. [Guidelines for the diagnosis and treatment of severe traumatic brain injury. Part 2. Intensive care and neuromonitoring]. Zh Vopr Neirokhir Im N N Burdenko 2016;80:98-106.
Medzon R, Rothenhaus T, Bono CM, et al. Stability of cervical spine fractures after gunshot wounds to the head and neck. Spine (Phila Pa 1976) 2005;30:2274-9.
Levy ML, Masri LS, Lavine S, et al. Outcome prediction after penetrating craniocerebral injury in a civilian population: aggressive surgical management in patients with admission Glasgow Coma Scale scores of 3, 4, or 5. Neurosurgery 1994;35:77-85.
Chong CL, Ware DN, Harris JH Jr, et al. Is cervical spine imaging indicated in gunshot wounds to the cranium? J Trauma 1998;44:501-2.